<%@ page language="java" import="java.util.*" pageEncoding="utf-8"%>
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
request.setAttribute("basePath", basePath);
String costInfoJson= (String)request.getAttribute("costInfoJson");
String respondResultJson = (String)request.getAttribute("respondResultJson");
%>
<link rel="stylesheet" href="${basePath}assets/bootstrap/css/bootstrap.css"/>
<link rel="stylesheet" href="${basePath}assets/css/basic.css"/>
<link rel="stylesheet" href="${basePath}assets/jquery-ui/jquery-ui.css"/>
<link rel="stylesheet" href="${basePath}assets/css/coding/edit_index_info.css"/>
<script type="text/javascript" src="${basePath}assets/jquery/jquery.min.js"></script>
<script type="text/javascript" src="${basePath}assets/layer/layer.js"></script>
<script type="text/javascript" src="${basePath}assets/bootstrap/js/bootstrap.js"></script>
<script type="text/javascript" src="${basePath}assets/jquery-ui/jquery-ui.js"></script>
<script type="text/javascript" src="${basePath}assets/My97DatePicker/WdatePicker.js"></script>
<script type="text/javascript" src="${basePath}assets/jqueryValidate/jquery.validate.js"></script>
<script type="text/javascript" src="${basePath}assets/jqueryValidate/localization/messages_zh.js"></script>
<script type="text/javascript" src="${basePath}assets/js/coding/edit_cost_info.js"></script>

<form action="${basePath}medical_record_coding/edit_cost_info" method="post" id="costInfoForm">
<input type="hidden" name="visitGuid" value="${visitGuid}">
<table style="width:99.5%;">
<tbody>
	<tr>
		<td colspan="6"><input type="submit" value="保存" class="btn" >
		</td>
	</tr>
	<tr>
		<td class="tdLabel_7 redColor" style="width:15%">总费用</td>
		<td class="tdLabel_8"><input type="text" name="totalCost"
			value="${costInfo.totalCost}">
		</td>
		<td class="tdLabel_7 redColor">自付金额</td>
		<td class="tdLabel_8"><input type="text"
			name="selfCost" value="${costInfo.selfCost}">
		</td>
	</tr>
	<tr><td colspan="6">综合医疗服务类</td></tr>
	<tr>
		<td class="tdLabel_7">(1)一般医疗服务费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[0].medicalCostTypeCode" value="C01001"/>
			<input type="hidden" name="costRecords[0].medicalCostTypeName" value="一般医疗服务费"/>
			<input type="text" name="costRecords[0].costMoney" />
		</td>
		<td class="tdLabel_7">一般治疗操作费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[1].medicalCostTypeCode" value="C01002"/>
			<input type="hidden" name="costRecords[1].medicalCostTypeName" value="一般治疗操作费"/>
			<input type="text" name="costRecords[1].costMoney" />
		</td>
		<td class="tdLabel_7">护理费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[2].medicalCostTypeCode" value="C01003"/>
			<input type="hidden" name="costRecords[2].medicalCostTypeName" value="护理费住院费"/>
			<input type="text" name="costRecords[2].costMoney" />
		</td>
	</tr>
	
	<tr>
		<td class="tdLabel_7">其他费用</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[3].medicalCostTypeCode" value="C01999"/>
			<input type="hidden" name="costRecords[3].medicalCostTypeName" value="其他费用"/>
			<input type="text" name="costRecords[3].costMoney" />
		</td>
		
	</tr>
	<tr><td colspan="6">诊断类</td></tr>
	<tr>
		
		<td class="tdLabel_7">(5)病理诊断费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[4].medicalCostTypeCode" value="C02001"/>
			<input type="hidden" name="costRecords[4].medicalCostTypeName" value="病理诊断费"/>
			<input type="text" name="costRecords[4].costMoney" />
		</td>
		<td class="tdLabel_7">实验室诊断费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[5].medicalCostTypeCode" value="C02002"/>
			<input type="hidden" name="costRecords[5].medicalCostTypeName" value="实验室诊断费"/>
			<input type="text" name="costRecords[5].costMoney" />
		</td>
	
		<td class="tdLabel_7">影像学诊断费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[6].medicalCostTypeCode" value="C02003"/>
			<input type="hidden" name="costRecords[6].medicalCostTypeName" value="影像学诊断费"/>
			<input type="text" name="costRecords[6].costMoney" />
		</td>
	</tr>
	<tr>
		<td class="tdLabel_7">临床诊断项目费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[7].medicalCostTypeCode" value="C02004"/>
			<input type="hidden" name="costRecords[7].medicalCostTypeName" value="临床诊断项目费"/>
			<input type="text" name="costRecords[7].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">治疗类</td></tr>
	<tr>
		<td class="tdLabel_7">(9)非手术治疗项目费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[8].medicalCostTypeCode" value="C03001"/>
			<input type="hidden" name="costRecords[8].medicalCostTypeName" value="非手术治疗项目费"/>
			<input type="text" name="costRecords[8].costMoney" />
		</td>
		<td class="tdLabel_7">临床物理治疗费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[9].medicalCostTypeCode" value="C03002"/>
			<input type="hidden" name="costRecords[9].medicalCostTypeName" value="临床物理治疗费"/>
			<input type="text" name="costRecords[9].costMoney" />
		</td>
		
	</tr>
	<tr>
		<td class="tdLabel_7">手术治疗费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[10].medicalCostTypeCode" value="C03003"/>
			<input type="hidden" name="costRecords[10].medicalCostTypeName" value="手术治疗费"/>
			<input type="text" name="costRecords[10].costMoney" />
		</td>
		<td class="tdLabel_7">麻醉费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[11].medicalCostTypeCode" value="C03004"/>
			<input type="hidden" name="costRecords[11].medicalCostTypeName" value="麻醉费"/>
			<input type="text" name="costRecords[11].costMoney" />
		</td>
		<td class="tdLabel_7">手术费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[12].medicalCostTypeCode" value="C03005"/>
			<input type="hidden" name="costRecords[12].medicalCostTypeName" value="手术费"/>
			<input type="text" name="costRecords[12].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">康复类</td></tr>
	<tr>
		<td class="tdLabel_7">(11)康复费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[13].medicalCostTypeCode" value="C04001"/>
			<input type="hidden" name="costRecords[13].medicalCostTypeName" value="康复费"/>
			<input type="text" name="costRecords[13].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">中医类</td></tr>
	<tr>
		<td class="tdLabel_7">(12)中医治疗费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[14].medicalCostTypeCode" value="C05001"/>
			<input type="hidden" name="costRecords[14].medicalCostTypeName" value="中医治疗费"/>
			<input type="text" name="costRecords[14].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">西药类</td></tr>
	<tr>
		<td class="tdLabel_7">(13)西药费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[15].medicalCostTypeCode" value="C06001"/>
			<input type="hidden" name="costRecords[15].medicalCostTypeName" value="西药费"/>
			<input type="text" name="costRecords[15].costMoney" />
		</td>
		<td class="tdLabel_7">抗菌药物费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[16].medicalCostTypeCode" value="C06002"/>
			<input type="hidden" name="costRecords[16].medicalCostTypeName" value="抗菌药物费"/>
			<input type="text" name="costRecords[16].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">中药类</td></tr>
	<tr>
		<td class="tdLabel_7">(14)中成药费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[17].medicalCostTypeCode" value="C07001"/>
			<input type="hidden" name="costRecords[17].medicalCostTypeName" value="中成药费"/>
			<input type="text" name="costRecords[17].costMoney" />
		</td>
		<td class="tdLabel_7">中草药费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[18].medicalCostTypeCode" value="C07002"/>
			<input type="hidden" name="costRecords[18].medicalCostTypeName" value="中草药费"/>
			<input type="text" name="costRecords[18].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">血液和血液制品类</td></tr>
	<tr>
		<td class="tdLabel_7">(16)血费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[19].medicalCostTypeCode" value="C08001"/>
			<input type="hidden" name="costRecords[19].medicalCostTypeName" value="血费"/>
			<input type="text" name="costRecords[19].costMoney" />
		</td>
		<td class="tdLabel_7">白蛋白类制品费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[20].medicalCostTypeCode" value="C08002"/>
			<input type="hidden" name="costRecords[20].medicalCostTypeName" value="白蛋白类制品费"/>
			<input type="text" name="costRecords[20].costMoney" />
		</td>
		<td class="tdLabel_7">球蛋白类制品费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[21].medicalCostTypeCode" value="C08003"/>
			<input type="hidden" name="costRecords[21].medicalCostTypeName" value="球蛋白类制品费"/>
			<input type="text" name="costRecords[21].costMoney" />
		</td>
	</tr>
	<tr>
		<td class="tdLabel_7">凝血因子类制品费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[22].medicalCostTypeCode" value="C08004"/>
			<input type="hidden" name="costRecords[22].medicalCostTypeName" value="凝血因子类制品费"/>
			<input type="text" name="costRecords[22].costMoney" />
		</td>
		<td class="tdLabel_7">细胞因子类制品费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[23].medicalCostTypeCode" value="C08005"/>
			<input type="hidden" name="costRecords[23].medicalCostTypeName" value="细胞因子类制品费"/>
			<input type="text" name="costRecords[23].costMoney" />
		</td>
	</tr>
	
	<tr><td colspan="6">耗材类</td></tr>
	<tr>
		<td class="tdLabel_7">(21)检查用一次性医用材料费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[24].medicalCostTypeCode" value="C09001"/>
			<input type="hidden" name="costRecords[24].medicalCostTypeName" value="检查用一次性医用材料费"/>
			<input type="text" name="costRecords[24].costMoney" />
		</td>
		<td class="tdLabel_7">(22)治疗用一次性医用材料费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[25].medicalCostTypeCode" value="C09002"/>
			<input type="hidden" name="costRecords[25].medicalCostTypeName" value="治疗用一次性医用材料费"/>
			<input type="text" name="costRecords[25].costMoney" />
		</td>
		<td class="tdLabel_7">(23)手术用一次性医用材料费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[26].medicalCostTypeCode" value="C09003"/>
			<input type="hidden" name="costRecords[26].medicalCostTypeName" value="手术用一次性医用材料费"/>
			<input type="text" name="costRecords[26].costMoney" />
		</td>
	</tr>
	<tr><td colspan="6">其他类</td></tr>
	<tr>
		<td class="tdLabel_7">(24)其他费</td>
		<td class="tdLabel_8">
			<input type="hidden" name="costRecords[27].medicalCostTypeCode" value="C99999"/>
			<input type="hidden" name="costRecords[27].medicalCostTypeName" value="其他费"/>
			<input type="text" name="costRecords[27].costMoney" />
		</td>
	</tr>
</tbody>
</table>
</form>
<script>
	$(function(){
		var costInfoJson = <%=costInfoJson%>
		var respondResultJson = <%=respondResultJson%>
		if(respondResultJson){
			if(respondResultJson.success){
				layer.msg("保存成功",{offset: '350px'});
			}else{
				layer.msg("保存失败",{offset: '350px'});
			}
		}
		console.log(costInfoJson);
		initPage(costInfoJson);
	});
</script>